It's not just serotonin that's too low! The key to treating depression: exercise more + taking medicine regularly for better results
A recent study claimed that the occurrence of major depressive disorder is not directly related to the “serotonin concentration” in the brain, overturning the past common understanding of depression in the academic community. Dr. Shen Wudi, the attending psychiatrist at Taipei Medical University-Wanfang Medical Center, pointed out in an interview that past analyzes and textbooks on depression have pointed out that depression is indeed related to insufficient serotonin concentration in the brain. The research results cannot be generalized, and more attention should be paid to treatment. “Multi-pronged approach”: In addition to replenishing serotonin in the brain, it is also necessary to reduce excessive norepinephrine, so that the patient’s prognosis and recovery can be better.
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Dr. Shen Wudi said that the causes of depression are relatively complex. From a physiological perspective, it is still generally believed to be related to insufficient secretion of serotonin in the brain. There are roughly three reasons: the first is caused by congenital genes and a family history of lack of serotonin in the brain; the second is long-term exposure to stress or drug abuse; the third is exposure to excessive radiation. In addition, serotonin is made from tryptophan, and its concentration needs to be increased by taking antidepressants or exercising. Therefore, the above-mentioned groups need to pay special attention to the risk of depression.
“In the past, the United States collected cerebrospinal fluid from people who committed suicide or mentally ill patients and found that their serotonin was indeed low. Therefore, the concentration of serotonin in the brains of patients is unlikely to be higher than that of ordinary people. This study is a meta-analysis. The results of the study Just for reference!”
Dr. Shen Wudi pointed out that melatonin is not easily absorbed by the human body. Melatonin will be destroyed by digestive enzymes. Melatonin and serotonin outside the brain cannot easily pass through the cerebrovascular barrier and be sent to the brain. Antidepressant drugs can produce serotonin and inhibit excessive norepinephrine in brain nerve cells, and finally produce BDNF (an important neurotrophic factor for the brain) in the nerve cell nuclei.
In addition, due to insufficient BDNF in patients with depression, the nerve cells in the hippocampal gyrus of the brain will be in a state of withering: the dendrites of the nerve cells that need to receive external chemical information will not be lush, and the axes of the nerve cells that need to send chemical information will not be strong; from the image On radiological examination, it can be seen that the volume of brain nerve cells has become smaller. Congenital genetic defects that regulate serotonin and norepinephrine lead to poor transmission of serotonin and norepinephrine, resulting in BDNF deficiency, which leads to depression. Approximately 25% of women and 12% of men in the population will suffer from depression at least once in their lives, and it is easy to relapse.
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The study also showed that patients with depression often took “selective serotonin retrieval inhibitors” (SSRIs, such as Prozac and Crocodile) to help recover. Dr. Shen Wudi explained that clinical depression is not only a low level of serotonin in the brain, but also an excessive level of norepinephrine in the brain.
SSRI drugs only involve “serotonin secretion”, and their effectiveness is indeed limited in terms of current depression treatments. Currently, patients with depression are mostly treated with serotonin and norepinephrine retrieval inhibitors (SNRIs, such as Qianzao, Suyue) or other dual-action antidepressants (i.e. Lhaso, Miyuting), which can At the same time, it can promote the secretion of serotonin in the brain and inhibit norepinephrine in the brain. Usually clinical evidence shows that depressive symptoms will be significantly improved within only 1-2 weeks, and depressive symptoms may be significantly relieved after 6 weeks.
In addition, a very small number of depression patients are related to abnormalities in dopamine transmission in the brain. In addition, newer drugs currently include “NMDA receptor antagonists”.
Dr. Shen Wudi emphasized that current treatment with dual-action antidepressants (SNRI or Lhasa) will increase the success rate of relieving depression symptoms. If patients follow medical advice and use medication accurately, they will have a higher chance of having a good prognosis; patients’ common sleep problems and emotional disorders can also be effectively alleviated, lost functions can be restored as soon as possible, and deteriorating interpersonal relationships can be improved. “Depression is a disease just like heart disease and high blood pressure. As long as you use the right medicine and take it regularly, the prognosis is actually very good! It is a disease that is easy to treat.”
How do people with depression relieve their symptoms? Doctors urge you to do 5 things
In addition to taking active medication, what measures can patients with depression take to reduce symptoms? Dr. Shen Wudi said that the aforementioned BDNF neurotrophic factor can also be enhanced through aerobic, muscle training and other exercise methods, which can improve some symptoms. Clinical experience has also found that people who have exercise habits are less likely to suffer from depression than those who do not exercise. “Patients with depression will have better recovery results if they continue to exercise and take medication together!”
In addition, patients with depression also need to pay attention to getting enough sleep. They need to sleep for about 7-9 hours depending on their personal conditions; those who are undergoing related treatment should avoid any alcohol, coffee, tea and other caffeinated drinks. They can drink them moderately in the morning, but after noon It should be avoided to avoid affecting sleep. People with relevant family history are advised to do more regular exercise.
However, there is still a certain chance that depression will relapse. Dr. Shen Wudi recommends that patients should actively take antidepressants and not stop taking them on their own to avoid ineffective treatment. If people feel that they have experienced more than 5 of the following 9 conditions recently, it is recommended to seek medical treatment as soon as possible:
Feeling sad or empty.
An apparent loss of interest in things.
Sudden weight loss or weight gain.
Sudden drowsiness or insomnia.
Movements become inexplicably agitated or slow.
Easily tired or lose energy.
Feelings of worthlessness or intense guilt.
Inattention or indecisiveness.
Frequent thoughts of suicide.
Dr. Shen Wudi emphasized that at least 1 and 2 of the 5 risks must be included so that there will be no “false positives”. “For example, in Western culture, people pay more attention to emotions and feelings. They will greet you with “How are you?”; Taiwanese people will greet you with “Are you full?”. Therefore, the first most common depression symptom (approximately 90%), to the 9th symptom of depression (only about 50%), ask one by one so that nothing is missed.”
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